Transcatheter valve-in-valve implantation (VinV-TAVR) for failed surgical aortic bioprosthetic valves
作者： Bernhard Wernly , Ann-Katrin Zappe , Axel Unbehaun , Jan-Malte Sinning , Christian Jung
DOI: 10.1007/S00392-018-1326-Z
关键词: Severity of illness 、 Aortic valve stenosis 、 Internal medicine 、 Stenosis 、 Survival rate 、 Aortic valve 、 Cardiology 、 Valve replacement 、 Hemodynamics 、 Regurgitation (circulation) 、 Medicine
摘要: We sought to investigate the procedural and hemodynamic outcome after valve-in-valve transcatheter aortic valve replacement (VinV-TAVR) for different surgical (SBV) (TAVR) bioprosthetic valves. 223 patients (76 ± 11years, STS-Score 8.3 ± 10.1) suffering from SBV failure treated with VinV-TAVR were enrolled at 6 centers across Germany. At time of intervention, majority in NYHA-class ≥ III (88%, n = 180). Failure mode SBVs was either stenosis, regurgitation (AR) or a combination both 85 (38%), 76 (34%) 62 (28%) patients, respectively. 138 (62%) first generation TAVR valves (Edwards Sapien XT CoreValve). Second implanted (38%) (Sapien 3, Medtronic CoreValve Evolut, SJM-Portico, JenaValve). associated high success rate, conversion surgery necessary 3 (2%) patients. After procedure, 4 suffered ≥ moderate AR. In (3%) second due mispositioning subsequent severe paravalvular Coronary obstruction observed Major bleeding cerebrovascular complications (according VARC) reported (1%) 30 days. Post-interventionally, 44/178 (25%) evidenced mean pressure gradient (mPG) ≥ 20 mmHg. Residual stenosis not increased mortality (HR 0.39; 95% CI 0.13–1.22; p = 0.11). SBV-failure is safe procedure resulting improvement common finding which can be 1/4 undergoing VinV-TAVR. However, this condition 1-year-mortality.
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